Based on public Medicaid payment data.
Matthew Jacobsen
Medicaid Provider in South Portland, ME
Type
Individual Provider
Address
20 Long Creek Dr
South Portland, ME 041062425
Phone
2077723027
NPI
1568453108
Procedures
2
Total Claims
103
Patients Served
80
About these costs
All amounts reflect Medicaid reimbursement rates, which are typically much lower than private insurance or cash prices. These figures show what state Medicaid programs actually paid this provider per claim.
Procedures & Average Costs
| Procedure | Avg. Paid | Claims | Patients |
|---|---|---|---|
| Dental Cleaning & Exam | $53.86 | 70 | 68 |
| Tooth Extraction | $91.00 | 33 | 12 |
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